Session 7 How Mayo Clinic Standardized Care Across

Session #7: How Mayo Clinic Standardized Care Across 22 Emergency Departments Christopher S. Russi, DO, FACEP Assistant Professor of Emergency Medicine Mayo Clinic College of Medicine Rochester, MN Pre-Session Poll Question Do you work in some capacity in or for your ED(s)? #HASummit 14 a) b) c) Yes No Not applicable

Poll Question #2 What is your role in your ED(s)? a) b) c) d) e) f) g) h) Physician / Admin (Medical Director) Admin Advanced Practice Provider (APP) APP / Admin Nurse / Admin Not applicable #HASummit 14 2

Integration Pyramid Continuum Degrees of integration Unified Multiple units merged into a single operating unit Integrated Standardized Coordinated #HASummit 14 Multiple units brought together by incorporating parts into a larger whole that works in unison within a matrix organization Multiple units agree to utilize single definition for an established value, quality, characteristic, or process in order to produce a uniform outcome or experience Multiple units organized to work in concert with each other where the value of the result is greater than the sum of the individual units

Why Integrate? Affordable Care Act Changes in Medicare reimbursement (probable commercial payer reductions as well) Expansion of Medicaid Leverage the “value equation” Need to operate clinically in a synchronous fashion • “Working differently” to reduce cost and improve quality • Examples: § Patellar fracture transfer § Direct admissions § Best practice dissemination § Migraine management § Keeping patients local #HASummit 14

A Gift? June 2012 Enterprise Integration Summit / Announcement • Suddenly we owned 21 Community Emergency Departments • Thanks, now what? • Urgent need to make a Division • EMERGENT need to improve staffing • No idea of the magnitude of what we just were gifted #HASummit 14

Emergency Medicine in the MCHS Background 1992 – 1 st site: Decorah • Contract services (county-owned facility) Next 21 years • 78 communities served • 21 EDs (Regional Structure) ‒ 10 Critical Access (CA) sites ‒ 3 contract services ‒ 2 Level-3 trauma centers, 1 Level-2 ‒ ~ 320, 000 annual visits* • 2 nd largest workforce in MCHS #HASummit 14

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Enthusiasm Redirected NIH KL 2 Scholar • Interested in developing a severe sepsis / septic shock treatment protocol transcending community to receiving centers Slam on the brakes… Why am I here? • Non-data and analytic approach #HASummit 14

How do we Integrate? Where do we begin? • 22 distinct cultures / personalities • Geographically and economically disperse • Variable provider (sometimes absent) workforce • Siloed recruiting, salaries, administration, and privileges • Staffing CRISIS • Focus on PEOPLE ‒ Wrong people = No engagement = NO integration #HASummit 14

Poll Question #3 Do you have locum tenens routinely staffing your EDs? a) Yes b) No c) Not applicable #HASummit 14 10

Immediate Strategy & Tactics • Road Trip – Invest in knowledge acquisition and relationship building • Salary Standardization / Correction • Right tools in place • EM Leadership Team / Medical Directors • Develop people • Eliminate locums #HASummit 14

My Job #HASummit 14 • Rapid evolution from the start • Vision and Strategy • Recruitment • Salary / Comp standardization • Advocacy at the C-Suite • Practice standardization • Education

Early Projects / Successes Large, functional, productive Division Centralized Recruiting Process • 18 hires in two years ‒ $75 K savings / FTE locum offset ‒ Heavy use of the CA position Bedside US APP Fellowship ‒ $210 K saving / FTE physician offset Create a shared staffing model (Mobile Workforce) • Web-based scheduling software • Singular privileging form #HASummit 14

Early Projects / Successes • Demonstrate Value of EM ‒ Reduced Transfers ‒ Reduction of Oncall need for Ortho / Anesthesia • Standardized Salary / Benefits • Move to a salary model • Midwest APP Medical Director • Logix Health Implementation ‒ $2. 2 m realized + $8 m estimate NOI increase • Nursing Standardized Education / Training • Fairmont & Red Wing ED Redesign #HASummit 14

Future Projects • Begin to standardize approaches to emergent conditions • q. Path (US billing) • Match providers to volume and acuity ‒ The APP transition • Develop a Midwest quality team ‒ Singular focus • Annual meeting / education event? #HASummit 14

Lessons Learned 1. Take a hard look at the current workforce. You may need to make substantial investments to correct issues. 2. Hire those with “fire in the belly. ” Those who are enthusiastic and believe in your mission should be your hiring focus. 3. Put the right leaders in the right places. 4. Doing the “right thing” is ok in the absence of supportive data/analytics. Don’t be paralyzed. #HASummit 14 16

Analytic Insights Questions & Answers A #HASummit 14 17

Choose one thing… Write down one thing will you do differently after hearing this presentation #HASummit 14 18

Thank You #HASummit 14 19

Session Feedback Survey 1. On a scale of 1 -5, how satisfied were you overall with this session? 1) Not at all satisfied 2) Somewhat satisfied 3) Moderately satisfied 4) Very satisfied 5) Extremely satisfied 2. What feedback or suggestions do you have? #HASummit 14 20

Upcoming Sessions Breakout Sessions – Wave 2 (2: 30 PM – 3: 15 PM) Location 10) Is Big Data a Big Deal…or Not? Grand Salon 11) Partners Healthcare Analytic Strategy for bundled Payments and Risk Management Grand Ballroom A 12) Sneak Peek: Improving Patient Engagement and Outcomes with Predictive Analytics Grand Ballroom D 13) How a Pioneer ACO is Using Analytics to Change Heart Failure Savoy 14) Entering Shared Risk for Community Hospitals Through Physician Engagement Murano Dale Sanders, Senior Vice President, Health Catalyst Richard Proctor, General Manager, Global Healthcare & Life Sciences, Hortonworks Sreekanth Chaguturu, MD, Vice President for Population Health Management, Partners Health. Care Helen Chan, Senior Manager, Business Planning, Partners Health. Care Gregory A. Spencer, MD, CMO & CMIO, Crystal Run Healthcare Louis G. Cervone, Jr. , Director of Business Intelligence, Crystal Run Healthcare Spencer H. Kubo, MD, CMO of Bio. Control Medical, United Heart &Vascular Clinic, Allina Integrated Medical Network Greg Stock, CEO, Thibodaux Regional Medical Center Mark F. Hebert, MD, FACS, Surgical Specialist, Thibodaux Regional Medical Center 15) Panel – Children’s Hospitals: “Tike-mares”…Are the Monsters Under Venezia the Bed For Real? #HASummit 14 21